【学位级别】医学博士

【论文完成日期】2004-5-17

【论文中文题名】早发与晚发精神分裂症患者及其子女的神经心理比较研究

【论文外文题名】Comparative study of neuropsychological test in patients with early-onset and late-onset schizophrenia and their offsprings

【论文著者】姓名：孙新宇 sun xin yu

【论文著者】学号：B10199769

【论文著者】系别：精神卫生研究所

【论文著者】专业：精神病与精神卫生学

【论文著者】研究方向：老年精神病学

【指导教师】姓名：于欣 yu xin

【指导教师】学校：北京大学医学部

【指导教师】系别：精神卫生研究所

【指导教师】专业：精神病与精神卫生学

【指导教师】姓名：沈渔邨 chen yu

【指导教师】学校：北京大学医学部

【指导教师】系别：精神卫生研究所

【指导教师】专业：精神病与精神卫生学

【中文文摘】研究目的 1． 了解早发与晚发精神分裂症患者临床特征和神经心理学特点的异同，探讨晚发精神分裂症的诊断分类； 2．比较早发与晚发精神分裂症患者及其子女的神经心理学特点，探讨精神分裂症病因和发病机制。 研究方法 纳入早发及晚发精神分裂症患者各36例，符合ICD-10，精神分裂症诊断标准，早发患者起病年龄小于35岁，晚发患者起病年龄大于44岁，两组根据性别、年龄、受教育年限配对；早发患者亲生子女16例，晚发患者亲生子女22例，排除精神分裂症及情感性精神障碍；正常青年及老年对照各21例。 调查早晚发患者的社会人口学资料、病史及临床特征。采用注意转换测验、划消测验、控制性口语联想测验、色词Stroop测验和威斯康星卡片分类测验,测查精神分裂症患者、子女及正常对照的注意力和执行功能。 研究结果 1． 早发和晚发精神分裂症患者都表现有广泛的认知功能损害，其总体神经心理特征一致；晚发精神分裂症患者认知损害的特征与精神分裂症特征性认知损害相符；早发与晚发精神分裂症患者. 2． 在阳性家族史、病前生活事件、精神病理学特征、社会功能保持方面存在差异。 3． 精神分裂症患者各神经心理指标间有相互关联，不同的临床特征具有相应的神经心理特征，提出精神分裂症认知损害分类假设。 4． 早晚发患者及其子女在某些神经心理特征上与正常对照不同，而且随年龄、文化程度变化的模式也与正常对照不同，验证了精神分裂症的神经发育假说。 结论 晚发精神分裂症与早发精神分裂症归属于同一疾病单元，具有精神分裂症特征性神经心理损害的特点。精神分裂症患者子女也存在神经心理损害，提示神经发育异常是精神分裂症的病理机制之一。

【外文文摘】Objectives 1. To explore the classification of late-onset schizophrenia by comparing clinical and neuropsychological characteristics of patients with late-onset schizophrenia and those of patients with early-onset schizophrenia. 2. To understand the aetiological and pathophysiological mechanism of schizophrenia, by comparing neuropsychological function in patients with schizophrenia， unaffected offspring whose parents suffer from schizophrenia and normal control. Methods 72 patients fulfilled with the ICD-10 criteria for schizophrenia were recruited in the study, whose age was older than 45, and onset age was older than 45 (late-onset group) or younger than 30 (early-onset group). The gender, age and education of patients were matched between two groups. 38 unaffected offspring whose parents suffer from late-onset schizophrenia and early onset schizophrenia were recruited. The two healthy control groups for patients and their offspring included 21 participants, respectively. The patients were investigated the aspects including demographic and clinical characteristics. All subjects were assessed with neuropsychological test focused on attention and executive functions, including Tests of Variables of Attention, Cancellation Test, Controlled Oral Word Association Test, Stroop Color and Word Test and Wisconsin Card Sorting Test. Results 1. Both late-onset schizophrenia and early-onset schizophrenia groups were significantly worse than the normal control on most of neuropsychological assessment in this study, and the characteristics of dysfunction were similar between two groups. The neuropsychological impairment in late-onset schizophrenia were consistent with what we said those in normal schziophrenia patients. The patients with late-onset schizophrenia differed from early-onset schizophrenia in positive family history, characteristics of psychopathology and social function. 2. The results for neuropsychological assessment were related each other. A classified assumption of cognitive impairment in patients with schizophrenia was put forward. 3. The unaffected offspring whose parents suffer from late-onset schizophrenia and early onset schizophrenia also had neuropsychological impairment compared with normal control, and the varieties according to age and education were different from those of normal control. It validated the “neurodevelopment hypothesis of schizophrenia”. Conclusion Both late-onset schizophrenia and early-onset schizophrenia belong to schizophrenia entity and their neuropsychological characteristics were consistent with the traits of schizophrenia. The unaffected offspring whose parents suffered from schizophrenia also had neuropsychological impairment, which support that neurodevelopmental abnormality was one of the pathophysiological mechanisms of schizophrenia.